The Nitty-Gritty – how I switched career paths two-thirds of the way through a residency program

Hi all, I’m back! You might have already read my post about my decision to do a second residency in a different field. This post is intended to be more of a bulleted list of things to consider in making this decision, as well as an explanation of how I actually applied to a second residency. Please take my advice with a grain of salt – my n=1 in this experience, and I know that my personal life doesn’t look like everyone else’s. Hopefully, this will help you if you’re in a similar situation and don’t know what steps to take next.

Questions I asked myself as I contemplated the decision to do a second residency:

• Could I be happy practicing in the field of my first residency without pursuing a fellowship? No – I did not relish the idea of general outpatient pediatrics, nor did I want to become a pediatric hospitalist.

• Could I be happy practicing as a pediatric intensivist after fellowship? Maybe, but I also knew that the following three years would be absolutely grueling and the job that followed wouldn’t be much easier. I also had serious concerns about my ability to practice long-term without severe burnout or depression becoming a constant specter in my life. 

• How much more would a second residency extend my training? For me, not by much. Matching into an advanced position in anesthesia residency would entail three years of my life, the same as a pediatric fellowship. A pediatric anesthesia fellowship itself would only take one extra year. 

• How would this decision affect my quality of life and earning potential? Like I already mentioned, my motivation to pursue anesthesia rather than pediatric critical care was largely driven by the ability to have an intellectually stimulating job that still allowed me to be happy. And as for earning potential – my first specialty choice was pediatrics, so clearly money isn’t at the forefront of most of my life decisions. I am also about as finance-savvy as a squirrel, so don’t ask me for actual calculations/projections about earnings. I knew that I would make more money as an anesthesiologist than as an intensivist or general pediatrician, and have a better quality of life to boot. 

• Should I finish this current residency? This is a thorny question. Residency isn’t really one of those jobs where you can just give a two-week notice, let alone rage-quit by taping your pager to the program director’s door. Beyond academic, professional, and scheduling issues that would arise from quitting mid-year, or even partway through, I felt a serious obligation to my co-residents to not duck out and shrink the call pool (in hindsight, this is not something for which I should have felt responsible, and is probably a red flag for a subtly toxic program/hospital that is overly dependent on resident labor, but that’s neither here nor there). At the point when I made my decision, I was ? of the way through a three year program, and my career goals at the time (pediatric anesthesia) made sense for me to stay. 

• Do I even remember how to talk to old people or treat flash pulmonary edema or replete potassium?No, you don’t. Well, you probably know how to replete potassium. But it will be fine, I promise. Even though your fresh-faced recently-graduated comrades will probably remember a lot more about renal tubular acidosis than you, the sum of your experiences will carry you very far. Your expectations for yourself are most likely way higher and way less realistic than the ones your peers and attendings have set for you.

Okay, so let’s do this thing. But how?

• First, I talked to people who had done something similar. As someone considering switching into anesthesia, I had lots of company. Anesthesia is a common second specialty for people leaving their original field. If you’re not able to find someone at your institution with whom you can connect, you can try looking at the specialty’s website for physician perspectives in the field.

• I started the application process.
  • You will need your MSPE and a new ERAS token. The MSPE (Medical Student Performance Evaluation) written by your medical school is still required for the ERAS, even if it feels like ancient history by this point. I emailed my former Dean of Students from medical school and asked for an ERAS token. She and some other folks in the administrative office helped me get a new ERAS token, upload my MSPE, and upload my transcript. You will also have to continue digging through your fun scrapbook of medical school memories and upload your USMLE transcripts. 
  • I got letters of recommendation. I recognize that this might look different – and cause differing levels of stress – for other applicants, but I had a pretty easy time asking for letters of recommendation. (Pediatricians tend to be pretty nice folks.) I had one letter from a pediatric anesthesiologist with whom I had worked closely during my rotations, a letter from my APD, a letter from the director of our PICU, and a letter from an attending in the ED. These were all the people I would have asked to write me letters if I had just applied to a PICU fellowship (save for the anesthesiologist). 
  • I filled out ERAS. It looked largely the same as it did when I filled it out in medical school. I felt weird and inadequate filling out the application after three years of doing mostly just work, rather than breaking my back to look good on paper. It’s okay if you don’t have a ton to add! Programs know that residents work hard, and you’re going to be judged by a different metric than the medical students with whom you’ll be interviewing. 

• I looked for programs. Again, this will look different for everyone. For family reasons, I applied only on the West Coast. I also knew that I did *not* want to do another intern year (who would?), so I only applied to programs that had advanced positions (in other words, programs that would let you do a prelim year separately and start as a PGY-2). Some programs (I think?) wanted you to have completed medical school within a certain number of years. When in doubt about whether the program would allow me to apply to an advanced position, I sent the coordinator an email to ask. In the end, I applied to less than ten programs, because staying on the West Coast was more important to me than completing anesthesia residency somewhere my husband and I didn’t want to live. 

• I interviewed. Overall, this process was a lot more relaxed than when I was a medical student. I had the patina of experience (and let’s face it, way more exhaustion) to dull some of those pre-interview jitters. People were genuinely interested in my life experience and very supportive of my decision to switch into anesthesia. No one tried to trip me up by asking obscure details about the half-assed research I did in medical school, and all the interviews were pretty friendly and laid-back. (I did have one program director tell me to my face that I would be unlikely to match at their program without consenting to do a repeat intern year in IM, a generous opportunity I gently declined. This was really the only “meh” interpersonal interaction I had.) Programs definitely *did* still care about numerical things like Step 1, overall med school class rank, etc, and my scores were explicitly discussed by several programs. As for my performance in pediatric residency, the only things they seemed to care about were my letters of recommendation. *Take everything I say with a grain of salt, as I’m willing to bet that an anesthesiologist practicing on the West Coast is just a scosche more relaxed than someone in the Northeast in a different specialty. 

• I ranked and matched! 

Part 1

Why I Switched Residency Programs & Specialties

The Nitty-Gritty – how I switched career paths two-thirds of the way through a residency program and the questions I asked myself as I contemplated doing a second residency….

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